This has to be one of the most comprehensive explanations of simple low back pain.
It explains the different types of low back pain, how we chiropractors and health care professionals classify it, what sort of nasties we're ruling out when we assess you, and most importantly, what YOU can be doing to help yourself!
Definitely worth watching...
Patients are always asking me if their problem is common. Have I seen anything like it before? Why them? Why has their back gone? Why have they been affected? I try to reassure them that they're not alone - low back pain, is unfortunately, a very common problem and, the majority of people will suffer from it at some point during their lives. However, it is difficult to find reliable evidence that answers this question - just how many people suffer with low back pain? It is easy to know how many people we see with back pain in a clinic, or how many people go to their doctor with a sore back, or even how many people take time off work with a back injury, but we don't know just how many people are walking around with low back pain on a daily basis.
Or, at least, we didn't - until recently. A reliable study,* published recently in a well-respected journal, has looked at just this question - what is the prevalence of low back pain in the general population? This study, conducted by the eminent Professor Charlotte Lebeouf-Yde over a one-year period, found an interesting pattern of low back pain in a random population of 50 year olds, revealing three distinct, but virtually equally-sized groups: 1) those who mainly do not have LBP (35%), 2) those who have it at times (30%), and 3) those who have it more or less always (35%). *Chiropractic & Manual Therapies 2013, 21:30
"35% of people have low back pain more or less always"
This is one of the few studies that is truly representative of the occurrence of low back pain the general population; participants were randomly selected, not chosen in response to a particular advert or from a particular place of work or a treatment clinic. They came from all walks of life, were from different socioeconomic backgrounds, had different levels of education and did all sorts of different jobs - so truly represented the 'normal, average Joe'. The participants were sent a text message every fortnight, asking them how many days their low back had bothered them, and how many days (if any) they'd had to take off work because of it. These regular text messages meant that the participants didn't have to rely on their memory and recall their pain over a long period, thus further enhancing the reliability of the data. Whilst there was some dropout from the study, the majority participated in the study for the whole year, giving a very valuable pool of data.
"3% had low back pain every day for a year!"
Further detailed analysis of the data revealed more - a lucky 19% of the sample did not experience any low back pain at all, whilst an unlucky 3% had low back pain every day for the entire year! 9% experienced some low back pain for several days every fortnight (but not every day) but the majority experienced episodes of low back pain lasting anything from a few days to a few weeks.
So, what does this study mean? It shows just how common low back pain is within the general population. Whilst a fortunate third of people didn't experience any low back pain at all in an entire year, the remainder experienced some intermittent or constant low back pain. From studies like this which show just how common low back pain is, we can also anticipate the knock-on effect that low back pain has at an individual and societal level - the impact on a person's everyday life with ongoing pain and disability, the number of days off work, the potential loss of income and the resulting cost to society, not to mention the burden on our already stretched NHS. It highlights the necessity to provide a solution to this enormous problem - like chiropractic treatment which hopefully will one day be widely accessible and freely available to all those who are suffering!
I recently read a fascinating article written by Richard Brown, chiropractor and President of the British Chiropractic Association, extolling the virtue of chiropractic treatment as a drug-free, non-surgical intervention for the management of spinal and musculoskeletal conditions. One of the core philosophical tenets of chiropractic is that it is a drug-free intervention. We chiropractors recognise the body's natural ability to heal and repair itself and the fact that, if looked after with appropriate diet and exercise, it will remain healthy and pain free. This key principal is neatly summarised in the New Zealand Commission of Inquiry's 1979 report:
"As we have seen, much is made by chiropractors of the drugless and non-surgical nature of their therapy. But modern chiropractors do not suggest that there is only one cause of disease; they admit there are limits to their expertise; and they acknowledge the need for medical intervention and medical monitoring. They do, however, place emphasis on the body's natural functioning and its natural recuperative powers.
In these matters of emphasis we see some value in the contribution that the chiropractic outlook can make to healthcare generally. There cannot be any fundamental objection to an attitude to healthcare which restricts drugs to cases where they are shown to be a matter of necessity rather than a matter of mere convenience. Nor can it seriously be suggested that anyone is unreasonable to believe that it is better for the body's disorders to be relieved if possible, by natural rather than artificial or chemical means".
Whilst more than 30 years old, this statement still holds validity today in our professional methodologies. Obviously, as spinal care experts, working in the modern, scientific world alongside other healthcare professionals, we chiropractors recognise the benefit and necessity for patients to sometimes take drugs and even undergo surgery. I am certainly not suggesting that anyone should stop taking any prescribed medications without appropriate medical advice, and indeed, at times I will refer my own patients to their GP to obtain appropriate pain relieving medication, understanding the fact that my patients' health and wellbeing is of paramount importance.
However, I am mindful of the fact that increasingly it seems that patients are turning away from drugs and surgery and are looking for an effective, research-driven form of natural healthcare. Something that gets to the root of the problem, and not just something that eases the pain or masks the symptoms. Added to which, ongoing scientific research and the media seem to increasingly highlight the complications, side-effects and contraindications for a number of commonly prescribed painkillers and anti-inflammatories, often readily doled out for the management of spinal and musculoskeletal pain.
It is not surprising then that people seek out a drug-free, but safe and effective alternative - like chiropractic.
I wasn't surprised by the research findings that the so typically British 'stiff upper lip' may deter patients from seeing their doctor, as they are too embarrassed to disclose their symptoms or fear that they may be 'wasting the doctor's time'. These findings, part of a more lengthy study published in the British Journal of Cancer, may go some way to explain the surprisingly lower than expected cancer survival rates in the UK, when compared with other developed nations, despite access to highly trained medical staff and cutting-edge treatment interventions.
A survey of nearly 20,000 people in the developed countries of UK, Canada, Australia, Denmark, Norway and Sweden revealed that one sixth of British men and women over the age of 50 were embarrassed to share their symptoms with their doctor, and a third were reluctant to visit for fear of being 'time wasters'. This could delay diagnosis and hence commencement of treatment - and early intervention is often the most critical factor in a successful outcome for the treatment of many cancers.
Fortunately, since we chiropractors primarily deal with problems affecting the musculoskeletal system, rarely do people present with cancers, or symptoms that might lead me to suspect anything more sinister. However, I am all too familiar with people's reluctance to disclose potentially important information that might help me to make the correct diagnosis and hence establish an appropriate treatment plan. All too often they might think that something in their history isn't relevant to their particular, current problem, or they might feel a little embarrassed or awkward about discussing things with me. However, I would urge all patients to provide me with as much information as possible - every consultation is totally confidential and we aim to provide you with a comfortable, relaxed, private environment. There isn't much that shocks me, and chances are, I've probably heard or seen similar before!
Whilst we chiropractors mainly treat the joints, muscles, nerves and soft tissues, we spend many years at University studying all the medical sciences, so we are trained to recognise and diagnose all sorts of illnesses and problems, not just those affecting the musculoskeletal system. So, if I were to pick up on something that I thought wasn't within my scope of practice, I would refer you on to your GP, or appropriate healthcare professional for further investigation (obviously with your permission).
Personally, I'm just like everybody else; I still squirm with embarrassment and sit there, on my clammy hands, giggling like a nervous schoolgirl, when having to discuss even the most minor of ailments with my GP. I even worry that I'm wearing 'sensible' clothing when seeing my own chiropractor! I faff around, delay making the appointment, fidget in the waiting room - and then feel so much better once it's done!
So, be brave and grab the bull by the horns. If you're worried about something it is far better to deal with it sooner rather than later, and if it is something serious, the sooner you get help the better! At least you'll have a definite answer to what the problem is - and this has got to be preferable to the sleepless nights, worrying and wondering and imagining the worst...
I enjoyed reading this article written by GB triathlete, Helen Russell. She writes about how chiropractic was available at the London Olympics, the first time that chiropractic was included as part of the mainstream core medical services within the Olympic village. It is estimated that nearly 90% of elite athletes use chiropractic treatment on a regular basis!
You can read the full article here...
I enjoyed the article, particularly the bit when Helen described her own beneficial experience of chiropractic treatment; she was treated by chiropractor, Stuart Herbert, at the Bromsgrove Chiropractic Clinic - I worked with Stuart many years ago when I had just qualified as a chiropractor!
The other day, I listened to an interesting piece on Radio 4's health programme, 'Inside Health' on dizziness and vertigo. A number of different types of dizziness were discussed, from orthostatic hypotension (the dizziness experienced when we stand up too quickly due to a temporary drop in blood pressure in the brain) to the management of Benign Paroxysmal Positional Vertigo, or 'BPPV'.
This wordy mouthful is a particular type of short duration, rotational dizziness or vertigo that is triggered by a change in head position - for instance when turning over in bed. BPPV is caused by disturbances in the balance receptors of the semicircular canal, buried deep within the inner ear. Sometimes, particularly as we get older, calcium deposits accumulate within the fluid of the inner ear and these tiny 'otoconia' can irritate the sensitive nerve endings, tricking our brain into thinking that we're moving when we're not. A simple test, called the Hallpike test, can be used to diagnose BPPV. Chiropractors are trained to carry out this test and diagnose BPPV and differentiate it from the other types of dizziness that may occur.
Medication has little effect in the treatment of this uncomfortable complaint, but there is a simple procedure that can be carried out that helps to reposition the otoconia within the semicircular canal so that they cease to irritate the sensitive nerve endings. This procedure, called the Epley manoeuvre, consists of specific sequence of head and body movements that reposition the loose fragments in the inner ear. The Epley manoeuvre is usually successful in 9 out of 10 cases, and can be repeated if the symptoms return. Not only can chiropractors diagnose BPPV but chiropractors can perform the Epley maneouvre too. So, if you're suffering from dizziness and find that medication isn't helping, it might be worth asking if we can fix it at the Llangefni Chiropractic Clinic!
We all know that good posture can not only improve your posture, but improve your overall appearance. We know too that standing up tall, with our tummies in, head held high and shoulders back makes you feel much better and look fantastic - taller, slimmer and generally poised - and can minimise back and neck pain.
Ideally, we'd all have the strength and discipline(!) to maintain our own posture, but finally, help is at hand. M&S and the British Chiropractic Association have joined forces and come up with the 'Perfect Poise' TM range of lingerie, a 3 piece range cleverly designed to support and improve your posture.
“The Perfect Poise TM range of bras, knickers and shapewear has been specifically designed to increase the wearer's awareness of correct posture by supporting them in key areas. The bra and body incorporate a patent pending supportive back panel and seam-free cups for a smooth silhouette.” Paschal Little, Head of Innovation, M&S Lingerie.
The bra and body use hidden back panels to encourage the wearer to keep their shoulders back and the high waisted knickers have an in-built lower back panel which encourages body alignment. They also slim and smooth the tummy to give a more flattened appearance!
Independent trials by M&S showed that 87% of the women who tried the undies felt that the products supported their back and the national press have followed the story - although recent reviews do say that they need to increase the cup-size range (currently 34B - 40E, sizes 8 - 22) to accommodate everyone.
‘"Perfect Poise TM lingerie has been designed with the modern woman in mind. Our contemporary aesthetic combines graphic sheer and opaque panels to create sculpted, sleek pieces which are discreet under clothing.’’ Soozie Jenkinson, Head of Lingerie Design, M&S.
I'm tempted to try them myself but regrettably require something a little smaller(!), but would love feedback from anyone who's tried them...
There's no doubt about it, ranking third in the official medals table, Team GB is storming ahead at London 2012. We've got a clutch of golds, excelling in a number of different events - athletics, rowing, cycling, clay pigeon shooting, gymnastics - and a number of no-less worthy silvers and bronzes.
Obviously, any athlete will have dug deep and trained exceptionally hard for many months, if not years, in order to achieve these stupendous results. What impresses me are the 'older' athletes, who might have been considered 'past it' or 'too old' to be a serious medal contender. Whilst 35 may not seem old to the majority of us, in the world of sports it would be seen as a serious hindrance. However, the likes of Chris Hoy (36), Greg Searle (40), Katherine Grainger (36), Mary King (51), Ben Aislie (35) and Beth Tweddle (27 - old for gymnastics!) have proved the ageist cynics wrong.
This Olympic performance is even more fitting in 2012 as it the European Year for Active Ageing. Emphasis is being placed on staying fit and active even as we get older, following the premise of 'use it or lose it'. The benefits of gentle, regular exercise (ok, maybe not to Olympic levels!) are well known - helping to keep the joints supple and the muscles strong, and improving the function of the cardiovascular system are just some of the more obvious ones.
I recognise the fact that I won't be making my debut at Rio 2016, even if I used to be pretty quick over the 100m, and wasn't too bad at the high jump or long jump, and could hold my own as stroke in a lightweight pair. However, watching the Olympics has certainly inspired me to keep active - even if my knees are beginning to get a bit crunchy. Hopefully, some of my patients are similarly inspired and will realise that with a bit of TLC and loosening up on the chiropractic bench they might be able to stay fit and active for a little bit longer.
Things are hotting up at the London 2012 Olympics. Only a few more days until the Opening Ceremony...
This week, the doors of the Athletes Village will open. Athletes and their support teams from 204 countries will start arriving. And, for the first time, chiropractors will be there!
Within the Athletes Village is the state of the art Polyclinic. Open 24 hours a day this multidisciplinary clinic is kitted out with some of the most sophisticated equipment in the country and staffed by highly skilled specialists - including, for the first time ever, chiropractors. It is expected that a high proportion of the anticipated 200 competitors visiting the polyclinic each day will be suffering from musculoskeletal injuries - sprains, strains, muscle injuries and joint pains - exactly the sort of problems that we chiropractors excel in treating. So, it is expected that the team of chiropractors are going to be kept busy, providing care from 7am - 11pm every day, with 24 hour emergency 'on-call' cover as well!
The state of the art Polyclinic in the Olympic Village
The team of chiropractors will be working alongside other musculoskeletal healthcare specialists - orthopaedic surgeons, neurologists, sports injury physicians - as well as other core services like dentistry, optometry, and physiotherapy. Together, this team of medical specialists will help to ensure that athletes are in their peak condition for this most important time in their sporting careers.
Richard Brown meets Lord Coe
Richard Brown, chiropractor and President of the British Chiropractic Association is one of the chiropractors who has taken time out of his busy practice and professional schedule to be treating the athletes. He had the opportunity to meet Lord Coe, Chairman of LOCOG, who voiced his support at the presence of chiropractors at the Olympics, and who said that his own career would have been far shorter, had it not been chiropractors.
Hopefully, Richard and the other chiropractors in the Polyclinic will be able to keep the competitors in tip top condition; here's hoping that they enable Jessica Ennis and a few of her fellow competitors to bring home some shiny medals...!
One of the things I love about my job is the great diversity of people that I see on a daily basis. Not only is it hugely satisfying to have the skills to be able to relieve someone's back or neck pain and watch them put their socks and shoes on and walk out of clinic when they have hobbled in, but I love the contact that I have with so many people from so many different walks of life.
In just one clinic I have had conversations about: holidays to Corfu; walking around Mont Blanc; the political and military situation in Afghanistan and Syria; sheep farming and the lambing season; the possibility of an extra silage harvest this soggy summer; the weather (where would we be without it?!); bereavement; Wimbledon (will Murray get to the finals this year?!); the unflattering cut of the Olympic Torch bearers' outfits; the risk of flying fast jets; the economy and whether Bob Diamond was right to resign; the bitter battle with cancer; diet, lifestyle and exercise regimes; gardening (including a great recipe for Raspberry Vodka!); the horrors and joys of childbirth; scuba diving; local crime and the Police's endeavours to deal with it; fishing; motor bikes and track days; and finally, nuclear fission (honestly!).
It is this interaction with my patients that keeps me going every day. It is my motivation for going to work each morning; not only do I have a responsibility to care for and treat my patients but I look forward to talking with them. It makes me a richer, more balanced person, and for that, I am grateful.
Eich Ceiropractydd yng Nghlinig Ceiropracteg Llangefnii